The ‘F.E.E.L.’ good factors in nursing leadership at the board level through to work‐based learning

Aim The aim of this commentary is to raise awareness about the apparent lack of formal activities and the paucity of published papers in nursing leadership development at the board level in the United Kingdom (UK). The paper suggests a way forward. Background The author has been serving at a board level, within and outside of nursing, locally, nationally and internationally since 1988. His current experience as an active board member and honorary treasurer of a leading charity organization in the Southeast of England and participation on a Board Leadership Development programme in the United States of America (USA) led to the need to write this commentary. Evaluation Leadership at the board level is different because the board is the governing body of an organization. The board has overall responsibility for running the organization. The overall duty is to manage less and LEAD more. The need for this type of leadership is on the increase because these are turbulent days in the healthcare industry. This growing trend witnesses increasing and greater demand from key stakeholders for nursing and healthcare services: rising exposure to liability and litigation; a demand for stronger accountability and questioning of the nature and delivery of nursing and healthcare services. Effective and successful leadership judgment is made based on both numbers [efficient resources utilization (RU)] and stories [effective client/patient satisfaction (CS)]. Conclusions Nurses and others in the healthcare industry need to guide against the leadership myths that: ‘everyone can be a leader’; ‘leaders deliver business (service) results’; ‘people who get to the top are leaders’; and ‘that leaders are great coaches’. This commentary demonstrates these myths could be converted to become realities through developing and possessing most if not all the knowledge, skills and attitudes implicated in the Effective Board Leadership Capabilities Development Profile presented in this paper. Implications for nursing management and leadership Possessing board level leadership capabilities is significant to nursing management and leadership from three key perspectives: the need for nurses to become ‘recognized’ leaders of the healthcare industry; possessing the knowledge, skills and attitudes relevant for effective board leadership; and the need to use the technology of the 21st century to aspire to an essentially intentionally global nursing community.     

Modification of Atrioventricular Conduction Using a Combined Laser-Electrode Catheter

Ablation of the AV junction is an accepted technique for the management of selected supraventricular tachyarrhythmias. Radiofrequency ablation appears to be safe and effective for AV junction ablation in most patients, but the need for firm tissue contact may make it less effective for ventricular tachycardia and certain ectopic atrial tachycardias. Laser energy can also be delivered through a catheter, and thus it may be an attractive alternative energy source for ablation. A new laser-electrode catheter was developed for modification of conduction through the AV node as a model for ablation of an arrhythmia substrate. A window for delivery of continuous-wave Nd:YAG laser energy was placed between the two electrodes of a bipolar electrode catheter. In vitro studies using a matrix of power versus time were performed to determine the energy that would create lesions of the appropriate size in vivo. Using this information, advanced AV block was successfully created in 16 of 17 dogs (94%) with the laser-electrode catheter. Advanced AV block was successfully created in all four dogs in the chronic study, and it persisted for 1-24 weeks of follow-up until sacrifice of the animals. Histologic examination demonstrated discrete thermal damage at the AV junction with no instances of septal perforation in the acute studies or progressive necrosis in chronically maintained dogs. Advanced AV block may be produced consistently and safely in dogs using a combined laser-electrode catheter.     

Right Coronary Artery Occlusion During RF Ablation of Typical Atrial Flutter

RCA Occlusion During RF Ablation . Right coronary artery (RCA) occlusion and acute myocardial infarction are rare during radiofrequency (RF) ablation of the cavotricuspid isthmus. Ventricular fibrillation (VF) or cardiac arrest in the periprocedural period may be the initial or only clinical manifestation. Septal or lateral RF delivery may increase the risk. We report 2 cases of RCA occlusion during ablation of typical atrial flutter (AFL). Angiographic and anatomical correlations are illustrated. One patient was ablated with a septal approach, the other with a lateral approach, and in each instance the RCA occluded near the ablative lesions. If septal or lateral ablation lines are contemplated during ablation of isthmus‐dependent atrial flutter, fluoroscopic or electroanatomic confirmation of catheter position is pivotal. Smaller tipped catheters, energy titration (to minimally effective dose), saline irrigation, or cryoablation should also be considered to help avoid this serious complication. (J Cardiovasc Electrophysiol, Vol. pp. 818‐821, July 2010)     

Intracytoplasmic sperm injection using surgically retrieved epididymal and testicular spermatozoa in cases of obstructive and non-obstructive azoospermia

This was a retrospective study of 115 patients who underwent 124 cycles of ICSI using surgically retrieved spermatozoa. The objective was to compare the results of ICSI in patients with obstructive azoospermia using epididymal spermatozoa (36 cycles) or testicular spermatozoa (58 cycles) with ICSI in patients with non-obstructive azoospermia using testicular spermatozoa (30 cycles). When epididymal spermatozoa were used for ICSI, the fertilization rate per injected metaphase-II oocyte and the clinical pregnancy rate per ICSI cycle were 60.4 and 25%, respectively. When testicular spermatozoa were used in obstructive cases, the fertilization rate and pregnancy rate were 57.9 and 34.5%. In non-obstructive cases the fertilization and pregnancy rates were 41.2 and 16.6%. When patients with obstructive azoospermia were regrouped according to the cause of obstruction, the fertilization and pregnancy rates were 59.1 and 35.1% in acquired obstruction and 58.7 and 24.3% in congenital obstruction. The fertilization and pregnancy rates were not statistically different ( p  > 0.05) when testicular or epididymal spermatozoa were used in obstructive cases; neither was statistically different ( p  > 0.05) when compared in patients with congenital and acquired obstruction. On the other hand, the fertilization and pregnancy rates in cases with non-obstructive azoospermia were significantly lower ( p  < 0.05) than in obstructive cases.     

Chronic Active Hepatitis in Jerusalem

Forty-three patients with biopsy proven chronic active hepatitis (CAH) were studied with special reference to the presence or absence of HBsAg. Evidence of hepatitis B virus (HBV) infection (HBsAg and/or anti-HBs) was found in 26 cases (60.5%). Thus, HVB is probably the most important etiologic factor of CAH in the Jerusalem area. fifteen cases (35%) were HBsAg-positive. This group was characterized by a higher frequency of males of Sephardic origin, a relatively frequent acute hepatitis-like onset, early presence of cirrhosis and portal hypertension and relative rarity of skin rashes, thyroid involvement and cholelithiasis. L.E. cells, cryoglobulin, paraprotein and positive Kahn-Wassermann tests were not found and antimitochondrial antibodies were less common. The mean level of serum albumin was lower while lg-G and lg-A were higher. Mortality was 7% during a mean follow-up period of 4.4 years. The antigen-negative group was characterized by a higher prevalence of skin rashes, thyroid disease and cholelithiasis. Peripheral lymphomonocytosis, high Ig-M levels and antimitochondrial antibodies were also more common. All cases with L.E. cells, cryoglobulin, paraproteinemia and positive Kahn-Wassermann tests were in this group. Anti-HBs antibodies were present in 42% of the cases. Mortality was 29% during a mean follow-up period of 5.4 years. Linear discriminant analysis with ten variables (sex, mode of onset, skin rash, levels of serum albumin, Ig-A, Ig-M, degree of BSP retention, presence or absence of L.E. cells, antimitochondrial antibodies and positive Kahn-Wassermann tests) classified correctly 100% of the cases. Sex, ethnic origin (Ashkenazic or other) and presence or absence of thyroid disease classified correctly 85% of the cases, thereby permitting a bed-side classification with a high degree of credibility.